002905 (SFD)ciityl
4
P.O. BOX 1504 No. 00295
Building 5:5-233 l �Ic LA QUINTA, CALIFORNIA 92253
Address _
Owner
BUILDING: TYPE CONST:
OCC: GRP.
Mailing - -
Address ���w; Club lkive
A.P. Number
City Zip
Tel.
.Paim. Desert .32269 , .
56$--21628
Legal Description
Project Description
TIM XRT - c;?, 15 A _
6.
Contractor
Address.:
' City ' "
Zip
Tel'.'
State Lic.
& Classif.
City
Lic. # �
D 1330
Sq. Ft.�
Size
No. No. Dw.
Stories Units
Arch.; Engr.,
Designer
New C.k Add ❑
Alter ❑ . Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic.-# .. ..
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that[ am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division`3.6f the Business and, Professions Code, and my license is in full force and
effect.
�s -
- ..
"
..- .. _ -O ._-DATE
_SIGNATURE:,.
OWNER:BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following•
_reason:(Sec. 7031.5,Business and Professions Code: Any city -or county which_ requires a
to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant'for.such permit to file a signed-statement.that he is licensed pursuant.to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of'the Business and Professions Code, or that. he is exempt therefrom; and "the basis.'
for the alleged exemption. Any violation of Section 7031.5..by 'any applicant for a opermit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). - •.
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
94p!44.00reason:
t
-PERMIT
.. ,
• .
- AMOUNT
. Plan .Chk. Dep..
Plan Chk. Bal.
- '
342.49
Const. ".
�� 00
- .
do the work, and the structure is not intended oroffered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not -apply to an owner of property who
Mech.
builds or improves thereon and who does such work himself -or through his own employees,
provided that' such improvements are not Intended or offered for- sale." If, .however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) -
Electrical
�($�L
Plumbing
- - 81' 50
'
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License_L'aw.
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
❑ 1 am exempt under Sec. B. & P.C. for this reason
S.M.1.
_
6.62 .
Grading
Driveway Enc.
Date Owner
Infrastructure
1,413.66
WORKERS' COMPENSATION DECLARATION
- I hereby affirm that'I have a certificate of consent'to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is -filed with the city. O Certified copy is hereby furnished.
TOTAL
.3..��
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
-
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) - -- '
I certify that in the performance of the work for which th-s permit is issued, I shall not
employ any person in any manner so as to become subject* to the Workers' Compensation
Laws of California.
Date' Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
ZONE: - BY:
Minimum Setback Distances:
Front Setback from. Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line '
hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
FINAL DATE
Issued by:
Validated by:
Validation:
A129;
INSPECTOR
Date Permit -
2 10 136226 4
Lender's Address
' This is a building permit when properly filled out, signed and validated, and is subject to '
expiration if work thereunder is suspended for 180 days.
I certify that.[ have read this application and state that the above information is correct.
I,agree to comply with all city and county ordinances and slate laws relating to building
construction, and hereby authorize representatives sof this city to enter the above./
- mentioned property for inspection purposes. /'
o - f "off
Signature of applicant . 11 Data
Mailing Address ' �""�" ��-/
City, State, Zip
r
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EURL
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB. f -J-?
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. Ff.
AS (ROUGH),5,-/ (� ��
J
DRINKING FOUNTAIN
SQ. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. . d
y
$ plus x$ _$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
-IdmALINSP�,,Lr^T
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
offCLATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FE PPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
ETBACK �
ROUND PLUMBIN /
UNDERGROUND
A.C. UNIT
COLL. AREA
?!HSLAB GRADE 3 t✓3�
ROUGH PLUMB. f -J-?
ON DING�2--e? —w
HEATING (ROUGH)
STORAGE TANK
e�KFORMS - l%1 �-.�'
SEWER OR SEPTIL3fOUGH
WIRING 7 ^S ��7
7
DUCT WORK
ROCK STORAGE
e26LFOUND. REINF. /� ��
AS (ROUGH),5,-/ (� ��
J
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
14 REINF. STEELS —,/4 ��
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
NAL INSP. 6 2!Zl.��
BOND BEAM
WATER SYSTEM
GRADING
cu. . d
y
$ plus x$ _$
LUMBER GR.
-IdmALINSP�,,Lr^T
d� -,FRAMING t - -�
INAL INSP. t,/- L�.�''l
ROOFING _7« L/� / yJ,
/
ox % o !�J/6t.
�Jc�[1�✓l GL
V _
A.,4 • C 5�^����! l
%L L!`
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
offCLATHING
MESH
6,61SISULATIONISOUND 5
FINISH GRADING
j?6erFINAL INSPECTION 6-JL,-�% 1
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL